Enhanced gait variability index and cognitive performance in Asian adults: Results from the Yishun Study.

BACKGROUND: Although gait variability has been linked to cognitive decline among older adults, the lack of a comprehensive composite gait variability score has dampened the application of gait variability. RESEARCH QUESTION: Does the enhanced gait variability index (EGVI) - a composite score gait variability index - provide differential and useful information on cognitive decline in community-dwelling adults from that using gait speed? METHODS: Healthy community-dwelling adults (n = 311) aged 21-90 were individually administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Habitual gait speed and spatiotemporal parameters were measured using a 6 m instrumented walkway system. The EGVI for each participant was calculated from five spatiotemporal parameters - step length(cm), step time(s), stance time(s), single support time(s) and stride velocity(cm/s). Linear regression models, controlling for age, gender, and education, were built to examine the independent effects of EGVI or gait speed on global cognition and individual domains. RESULTS: Multiple regression revealed that gait speed contributed significantly to the performance of the domain "Attention" (p = 0.04) whereas EGVI contributed significantly for the performance of the domain "Visuospatial" (p = 0.04) and "Delayed Memory" (p = 0.02). SIGNIFICANCE: EGVI provides differential and useful information from using gait speed alone. The EGVI may offer a solution to measure or track GV changes in relation to cognitive changes.

Coexistence of osteoporosis, sarcopenia and obesity in community-dwelling adults - The Yishun Study.

OBJECTIVES: To 1) report prevalence of 'osteosarcopenia' (OS) and osteosarcopenic obesity (OSO) entities using evidence-based diagnostic techniques and definitions, 2) examine if OSO offers additional predictive value of functional decline over its components, and 3) identify associated factors in a multi-racial Southeast Asian population. METHODS: We performed a cross-sectional study of a representative sample of 542 community-dwelling adults (21-90 years old), and assessed anthropometry, cognition, functional performance, and self-report sociodemographic, health and lifestyle questionnaires. Low muscle mass, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, were used to assess sarcopenia. Obesity was defined using percentage body fat and fat mass index. Osteopenia/osteoporosis was determined using lumbar spinal bone mineral density. Associated factors were examined using logistic regression, and OSO's value investigated using linear regressions with functional performance. RESULTS: OS and OSO prevalence were 1.8% and 0% (21-59 years), 12.9% and 2.8% (≥ 60 years), 17.3% and 4.1% (≥ 65 years), and 25.5% and 7.0% (≥75 years), respectively. OSO entity as defined was not a significant predictor (P > 0.05) and did not improve explanations for functional decline over sarcopenia or sarcopenic obesity. Age, sex, race and body mass index (BMI) were associated with OS, while age, sex, race and alcoholism were associated with OSO. CONCLUSIONS: Our results do not support OSO as a distinct entity in relation to functional decline. Aside from biological age, sex, and race, amenable lifestyle factors such as BMI and alcohol intake are important variables that can influence the co-existence of osteopenia/osteoporosis, sarcopenia and obesity.

Effectiveness of Community-Delivered Functional Power Training Program for Frail and Pre-frail Community-Dwelling Older Adults: a Randomized Controlled Study.

Translation of community-based functional training for older adults to reduce frailty is still lacking. We evaluated the effectiveness and implementation of a community-delivered group-based functional power training (FPT) program for frail older adults within their neighborhoods. A two-arm, multicenter assessor-blind stratified randomized controlled trial was conducted at four local senior activity centers in Singapore. Sixty-one community-dwelling older adults with low handgrip strength were randomized to intervention (IG) or control (CG) group. The IG underwent the FPT program (power and balance exercises using simple equipment) delivered by a community service provider. The 12-week program comprised 2 × 60 min sessions/week. CG continued usual activities at the centers. Functional performance, muscle strength, and frailty status were assessed at baseline and 3 months. Program implementation was evaluated using RE-AIM framework. The program was halted due to Coronavirus Disease 2019-related suspension of senior center activities. Results are reported from four centers, which completed the program. IG showed significantly greater improvement in the Short Physical Performance Battery test as compared to CG (p = 0.047). No effects were found for timed up and go test performance, muscle strength, and frailty status. The community program exhibited good reach, effectiveness, adoption, and implementation. Our study demonstrated that FPT was associated with greater improvement in physical function in pre-frail/frail participants as compared to exercise activities offered at local senior activity centers. It is a feasible intervention that can be successfully implemented for frail older adults in their neighborhoods. Trial registration ClinicalTrials.gov, NCT04438876. Registered 19 June 2020-retrospectively registered.

Fast gait spatiotemporal parameters in adults and association with muscle strength - The Yishun study.

BACKGROUND: There is limited data on fast gait speed and spatial-temporal parameters across age groups among Asian adults, and the associations between upper and lower extremity muscle strength with gait. RESEARCH QUESTION: What values characterise fast gait spatiotemporal parameters across the age groups of an Asian population? Are hand grip strength (HGS) and knee extension strength (KES) associated with fast gait speed and spatiotemporal parameters? METHODS: Healthy community-living adults between 21-90 years (n = 487) were recruited. Fast gait was assessed using a 6 m instrumented walkway, and spatiotemporal parameters including variability for fast gait speed, stride length, stride width, stride time, stance time, swing time, single support time and double support time were analysed. Maximum HGS and KES were also assessed. Linear regression modelling was used to explore the association of HGS and KES with fast gait speed, spatiotemporal parameters and their variability. RESULTS: Age reduced fast gait speed and stride length, but increased stride width, stance time, stride time and double support time. Age increased all investigated gait variabilities except stride width variability. Gender differences were observed for all gait features except for fast gait speed and double support time. Both HGS and KES were positively associated with fast gait speed in both young and old adults. KES was positively associated with spatiotemporal variations in stride length, stride time, stance time and double support time. HGS was also significantly associated with two additional temporal parameters - positively with swing time and negatively with double support time variability. SIGNIFICANCE: The data from this study contributes to reference values database for the use of fast gait assessments in adults.

Sensorimotor Performance and Reference Values for Fall Risk Assessment in Community-Dwelling Adults: The Yishun Study.

OBJECTIVE: This study sought to answer the following questions: What are the reference values of sensorimotor performance for fall risk in community-dwelling adults? How do population norms compare with that of other populations? Are younger adults at risk of falls? METHODS: In a cross-sectional study design, sensorimotor functions and fall risk scores of community-dwelling adults were assessed and calculated to derive corresponding fall risk categories. Reference values were determined using the average scores by age group. A total of 542 community-dwelling adults were recruited (21-90 years old) across 10-year (21-60 years) and 5-year age groups (>60 years) to obtain a representative sample of community-dwelling adults in Singapore. Five physiological domains were assessed: vision, proprioception, muscle strength, reaction time, and postural balance according to the Physiological Profile Assessment (PPA). Fall risk scores and the corresponding fall risk profiles were generated from an online calculator. RESULTS: Sensorimotor performance and PPA fall risk scores were significantly worse for increasing age categories. Females had significantly slower reaction time, lower muscle strength, and higher fall risk. The representative sample of older adults (≥65 years) performed poorer in postural sway (z = -0.50) and reaction time (z = -0.55), but better in proprioception (z = 0.29) and vision (z = 0.23) compared with Caucasian norms. Among younger adults (21-59 years), 36.8% appeared to exhibit higher fall risk. CONCLUSION: This study presents important reference data and compared sensorimotor functions and physiological fall risk across age groups of community-dwelling adults in a Southeast Asian population. Poor sensorimotor performance and fall risk appear already pertinent in younger adults. Further studies are warranted to improve understanding of fall risk among younger adults. IMPACT: In physical therapist practice, PPA reference values can aid clinicians in the development of targeted interventions tailored towards an individual's physiological risk profile, addressing specific physiological systems that require particular attention.

Prevalence and Associated Factors of Sarcopenia in Singaporean Adults-The Yishun Study.

OBJECTIVES: To describe the normative values of sarcopenia among community-dwelling adults (≥21 years of age); compare the prevalence of sarcopenia using Asian Working Group for Sarcopenia criteria, 2014 (AWGS2014), Asian Working Group for Sarcopenia criteria, 2019 (AWGS2019), and European Working Group on Sarcopenia in Older People criteria, 2018 (EWGSOP2) guidelines; and identify factors associated with sarcopenia. DESIGN: Participants were recruited through random sampling. Sarcopenia assessments were performed using a dual-energy x-ray absorptiometry scan (muscle mass), handgrip test (muscle strength), and usual walking test (physical performance). Questionnaires were administered to evaluate lifestyle and cognition. SETTING AND PARTICIPANTS: In total, 542 community-dwelling Singaporeans were recruited (21‒90 years old, 57.9% women). METHODS: We assessed anthropometry, body composition, and questionnaire-based physical and cognitive factors, and estimated sarcopenia prevalence according to the AWGS2014, AWGS2019, and EWGSOP2 recommendations, and examined associations using logistic regression. RESULTS: According to AWGS2019, the Singapore population-adjusted sarcopenia prevalence was 13.6% (men 13.0%; women 14.2%) overall, and 32.2% (men 33.7%, women 30.9%) in those aged 60 years and above. The cut-offs derived from young adult reference group for low appendicular lean mass index were 5.28 kg/m2 for men and 3.69 kg/m2 for women (lower than AWGS recommended cut-off); for gait speed it was 0.82 m/s, (AWGS2019 recommended cut-off 1.0 m/s, AWGS2014 cut-off was 0.8 m/s); and for handgrip strength it was 27.9 kg/m2 for men and 16.7 kg/m2 for women (close to AWGS2019 recommendation). Age, sex, marital status, alcoholism, physical activity, body mass index, waist circumference, and global cognition were associated with sarcopenia (P < .05). CONCLUSIONS AND IMPLICATIONS: This is the first study to provide reference values of muscle mass, strength, and gait speed across the adult lifespan of Singaporeans. Using AWGS2019 criteria, sarcopenia is prominent in older age (32.2% in ≥60 years old), but it is already nontrivial (6.9%) among young and middle-age persons. Multidomain lifestyle modifications addressing muscle strength, cognition, and nutrition over the adult lifespan are important to delay the development of sarcopenia.

Reference Values of Gait Speed and Gait Spatiotemporal Parameters for a South East Asian Population: The Yishun Study.

BACKGROUND: Age-related slowing of gait has been reported to start as early as the fifth decade and accelerate beyond the seventh decade of life. A single cut-off for slow gait may not be appropriate for men and women of different ages. We aimed to report reference values for gait speed and spatiotemporal gait parameters of adult age groups in a South East Asian population. METHODS: A total of 507 community-dwelling adults, aged 21-90 years were recruited into the study through random sampling, filling quotas of 20-40 participants in each sex and age group (10-year age groups between 21 and 60 years; 5-year age groups beyond age 60 years). Demographic data, height, weight and information on comorbidities were recorded. Habitual gait speed and spatiotemporal parameters were measured, and the average of three trials was recorded using the GAITRite system. RESULTS: Gait speed peaked in their 40s for both men and women, but the trajectories differed slightly across age groups. Although similar for men in their 50s and 60s, gait speed was significantly slower among those aged 71 years and older. For women beyond 50 years old, gait slowed with age. After adjusting for height, women were found to walk significantly faster and with a longer step length than men. Women also walked with a significantly narrower stride width and less external rotation of the feet. The lowest quintile for gait speed in our study cohort was 0.9m/s, below the recommended cut-off of 1.0m/s. CONCLUSION: We established the reference values as well as the quintiles for gait speed and spatiotemporal gait parameters across adult age groups in a multi-ethnic Asian population. This contributes to a valuable database for gait assessment and evaluation of preventive or rehabilitative programs.

Feasibility of a community-based Functional Power Training program for older adults.

PURPOSE: Community-based programs can increase and sustain physical activity participation in older adults, even for those who are physically frail. We studied the feasibility and potential effect of a 12-week structured Functional Power Training (FPT) program involving high velocities and low loads for older adults conducted in a common area of their housing estate. PATIENTS AND METHODS: The structured FPT program was conducted in collaboration with a health promotion social enterprise and a community service provider based in a public housing site. We recruited nine inactive residents as participants to the single, group-based, twice-weekly program. Attendance and adverse event(s) were recorded throughout the program. The Short Physical Performance Battery, Timed Up and Go (TUG), and 30s Sit-to-Stand tests were used to assess functional outcomes pre- and postprogram. The FRAIL Scale was used to assess their frailty status, and a postprogram experience survey was conducted. RESULTS: Eight subjects (aged 74±10 years) completed the program with an average overall attendance of 90.3%, with at least five participants present for each session. Changes in functional outcomes showed a moderate-to-large effect with significant improvement in TUG (p<0.01). In addition, participants either reversed or maintained their frailty status (p<0.01). Overall, the program was perceived to be well structured, engaging, as well as providing physical and psychosocial benefits. No exercise-related adverse events occurred during the program, and participants were keen to recommend this program to others. CONCLUSION: Community-based structured FPT is safe and feasible for frail older adults, with the potential to improve function and reverse frailty status.